Headaches are one of the most common ailments, and afflict millions of individuals. The specific etiology of headaches may be difficult to pinpoint. Known sources of headache pain include trauma and vascular, autoimmune, degenerative, infectious, drug and medication-induced, inflammatory (sarcoid), neoplastic (primary or metastatic), metabolic-endocrine, iatrogenic (such as post-surgical), muscloskelatal and myofascial causes. Even if the condition underlying the headache pain is identified and treated, headache pain may persist.
Currently, the sphenopalatine ganglion (SPG) is a target of manipulation in clinical medicine to treat headaches. The SPG is a neuronal center located outside of the brain behind the nose. It consists of parasympathetic neurons innervating the middle cerebral and anterior cerebral lumens (in part), the facial skin blood vessels, and the lacrimal glands. Manipulation of the SPG is mostly performed in attempted treatments of severe headaches, such as cluster headaches.
Various clinical approaches have been used to modulate SPG function and treat headaches. These procedures vary from least invasive (e.g., sphenopalatine blocks using lidocane or cocaine, which provide 30%-85% relief of pain on a temporary basis) to much more invasive (e.g., surgical resection of the SPG, radiofrequency gangliorhizolysis, and gamma knife radio surgery). These later procedures are very invasive, and most are non-reversible. In both cases, the surgical approach is typically through the nostrils or the greater palatine foramen.